perinatal psych Flashcards
what kinds of psychiatric problems do women have during pregnancy?
- depression
2. BPAD
psych probs post partum?
- baby blues
- peurpeural psychosis
- post natal depression
most common cause of maternal mortality is ______
suicide
rate of depression in pregnancy?
as for baseline
10% risk of depression in T1 if?
- past hx
- previous abortion
- previous IUD
- unwanted
psych admission and suicide in pregnancy are ______ common than other times
less
risks of untreated depression in mum?
- risk PND
2. risk to baby from maternal neglect
how to tx depression in pregnancy?
as for normal adult
can maternal anxiety affect baby?
yes, in terms of foetal heart activity and heart rate
high stress = 2x risk of preterm birth
affects sleep in babies and toddlers
BUT are these associations real biological?
cortisol and psych distress in pregnancy?
increased cortisol = lower fetal weight
also increased intrauterine arterial resistance = LBW
negative consequences of maternal depression are related to _________
length of illness
incidence of baby blues
50-75% new mums
presentation baby blues
- tearful
- irritable
- distress
- sometimes brief high
course of baby blues?
transient - strts 2nd day ish and lasts max 72hrs
tx for baby blues
supportive
if prolonged = risk PND
RFs for baby blues?
hx of bad PMS or mood changes on anovulant OCP
PND incidence?
10-15% all mothers
PND what is it?
not one disorder - combo:
depression
anxiety
adjustment
PTSD
course of PND?
90%
recurrence rate PND?
20%
symptoms of PND
as for depression
20% mum has trouble relating to the baby after delivery
RFs for PND?
- previous depression
- difficult labour
- fhx
- difficult pregnancy
- previous conflict arounf pregnanyc, MC, termination, SB
- lack of support
- lack of self esteem
mx of PND
- early detection
- prevent with education + support
- brief CBT
- meds
- risk assessment
how is PND measured?
Edinburgh PND scale
incidence of PPP?
0.1-0.2% (1/500)
onset of PPP?
2 weeks after delivery
type of PPP?
- affective (80%) or non affective
- 15% schizophreniform
- 5% organic
cause of PPP?
unknown
RFs for PPP?
previous hx affective psychosis fhx affective disorders previous hx of PPP previous SB, MC, termination major life event in pregnancy lack social support
risk of recurrence PPP?
60% +
tx of PPP?
- risk assessment - infanticide or suicide
- meds: antipsychotics, antidepressants, mood stabilisers
- ECT in depressive psychosis
- admit to mum and baby unit
- need psych support and social support
when is max teratogenicity in pregnancy?
17-60 days
what is the normal spontaneous major malformation rate?
2-3%
meds + major malformations?
only account for 5%
1st trimester drugs _____
major malformation
3rd trimester drugs _______
neonatal toxicity
In T3 dosing may need to be ______
increased due to rise in blood volume
mum on drugs, monitor neonate for ________
withdrawal
recommendations for depression tx in pregnancy?
high risk relapse:
1. maintain on AD tx
developed depression during pregnancy:
1. psych first then meds
what meds okay for depression in preg?
amitryptline
imipramine
fluoxetine
what antidepressant to not use in pregnancy?
paroxetine
venlafaxine
high risk discontinuation sx in neonate
prescribing for psychosis in pregnancy rules?
- plan pregnancy
- if high relapse rate then keep on antipsych during and post
- try keep dose low as poss
- maintain on whatever they are currently on unless issue with it
what antipsych okay in pregnancy?
chlorpromazine
haloperidol
olanzepine
clozapine
if poss switch atypical to typical - more data
discontinuation sx in neonate?
crying
agitation
increased suckling
folate and atypicals
low folate levels
prolactin and fertility?
decreases it!
antipsychotics are teratogenic?
no evidence
BPAD mx in pregnancy?
- can withdraw meds if long time no relapse
- don’t stop suddenly- high risk relapse
- keep on meds if high relapse
- no mood stabiliser safe
lithium - must screen for ______ at ______ weeks
ebsteins anomaly
6 and 18
if on anticonvulsant meds need to give _______
more folate
vit K after delivery
_______ is associated with cleft palate
lamotrigine
_________ is the most teratogenic mood stabiliser
valproate
effects on foetus of anticonvulsants?
- growth retarded
- developmental delay
- NTDs
- specific syndromes
risk of ebsteins anomaly on lithium
1/1000
risk of relapse in BPAD maintained on lithium?
50%
benzos in pregnancy?
- avoid in T1
2. avoid hihgh dose late in pregnancy - hypotonia, hypothermia, resp depression, withdrawal
diazepam can cause a ______
cleft lip
which psychotropic drugs are licensed in pregnancy?
none
psychotropics in breastfeeding?
- monitor infants for effects/ feeding patterns/growth
- don’t stop tx
- use lowest effective dose
- no polypharm
- time feeds to avoiod peak drug levels or express and give later
antiD in breastfeeding?
paroxetine or sertraline
antipsychotics in breast feeding?
olanzepine
sulpiride
mood stabilisers in BF?
avoid if poss
valproate if must
sedatives in BF?
lorazepam for anxiety
zolpidem for sleep
types of meds good in BF generally?
has worked before
was on in pregnancy
short half life
